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Chronic Disease in the Workplace: Are We Fighting the Wrong Battle?

Al Lewis wears multiple hats, both professionally and also to cover his bald spot. As founder of Quizzify, he has married his extensive background in trivia with his 30 years experience in healthcare to create an engaging, educational, fully guaranteed and validated, question-and-answer game to teach employees how to spend their money and your money wisely. As an author, his critically acclaimed category-bestselling Why Nobody Believes the Numbers, exposing the innumeracy of the wellness field, was named healthcare book of the year in Forbes. As a consultant, he is widely acclaimed for his expertise in population health outcomes, and is credited by search engines with inventing disease management. As a validator of outcomes, he consults to the Validation Institute, part of an Intel-GE joint venture.
While it is impossible to prove a negative, employers appear to be focusing on none of these items, partly explaining the composition of the list. And a simple review of the employee health trade journals shows far more emphasis on chronic disease screenings than avoiding low-value care. The authors have discovered no health risk assessment—another standard tool for wellness programs—addressing these procedures, and they believe none is in common use.
Wellness proponents might argue that wellness could reduce the incidence of many of these DRGs by helping employees lose weight. However, employer weight-loss incentives don’t seem to help employees lose weight. And in the most recent award-winning wellness program (McKesson’s), BMI actually increased. If award-winning programs can’t reduce BMI, it’s difficult to see how lesser programs could.
Bariatric surgeries (number 15) are on the list. One could argue they represent either the failure of wellness programs or their irrelevance. Either way, if employers really could help obese employees lose weight, it’s as unlikely this category would appear in the top 25 as it is that employees of a corporation with an award-winning program could gain weight.
Sepsis makes the top 10. This problem could be addressed with benefits design the way Medicare does it: pay hospitals more for each case, but don't pay them for hospital errors and infections, thus giving hospitals an incentive to reduce infection rates. The ranking of infections should steer more employers towards membership in, for example, the Leapfrog Group, which emphasizes the importance of reducing hospital errors and infections.
Should the Federal Government Change Course?
The federal government is moving in exactly the opposite direction suggested by the data: it is encouraging companies to identify and prevent chronic disease events. At the legislative level, the Senate Health, Education Labor and Pensions Committee held a hearing titled Employer Wellness Programs: Better Health Outcomes and Lower Costs. (No witnesses intending to challenge the title’s premise were invited to testify.)
In the executive branch, the Equal Employment Opportunity Commission (EEOC) is actively considering regulatory changes under the Americans with Disabilities Act that would classify participation in any wellness program, no matter how large the fines up to the ACA limits, as “voluntary,” thus depriving employees of any rights of recourse for perceived unfair treatment. Likewise, the EEOC’s proposed changes to the Genetic Information Nondiscrimination Act would have the practical effect of stripping employees of the right to voluntarily withhold their medical and genetic information from their employers.
The HCUP data suggests that the focus of both branches of government should be elsewhere, such as encouraging employers to help employees avoid low-value care.
As it stands today, employers are allowed to demand intrusive medical exams and even employee DNA, and if employees don’t comply, they can be fined. But they can't simply tell employees: "You need to complete this education module on the benefits and hazards of spinal fusion before being approved for one.” In addition to being unable to penalize employees for overuse or incentivize them to avoid overuse of inappropriate care, employers aren’t even allowed to know about employees’ decisions to get it.
After having just criticized wellness programs for being too prescriptive, we don’t want to be too prescriptive ourselves. Deeper dives are needed to figure out where the greatest policy and corporate opportunities are.
Nonetheless, at a very minimum, the data suggests that a pause in the headlong rush to “do wellness” is advisable while more research is undertaken to identify the best opportunities to help guide policy makers, employers, and health plans on where to focus their educational resources.

1. The “most of which are preventable” modifier that often precedes this statistic appears to have originated with Johnson & Johnson. If that were true in anything like a literal sense, many people could live forever. 

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